Page 29 - ACCCN's Critical Care Nursing

6 S C O P E O F C R I T I C A L C A R E

was a foundation member of the WFCCN and a member of critical care outreach or ICU liaison nurse roles (see
association of the World Federation of Societies of Inten- Chapter 2 for further discussion of these services).
sive Care and Critical Care Medicine, and maintains a In practice, the role of clinical consultant and that of an
representative on the councils of both these international advanced practice nurse or nurse practitioner can become
bodies. (See the ACCCN website, listed in Online resources, blurred, with hospital administrators believing that one
for further details about professional activities.)
role can replace the other. Clearly, however, the con-
ROLES OF CRITICAL CARE NURSES sultant’s role has a broader portfolio, with a focus on
supporting clinical colleagues in providing safe, quality
As the discipline of critical care has developed, so too has patient care, while the role of advanced practice nurse or
the range of roles performed by specialty critical care nurse practitioner has a direct patient care focus (see
nurses. 40,41 The continuum of critical illness (see Chapter below).
4) includes pre-crisis/proactive care, management of the
critical illness, and follow-up care in hospital, clinic and ADVANCED PRACTICE NURSE/NURSE
42
home settings. This continuum also includes the prac- PRACTITIONER
tice of palliative care in the ICU environment. Clinical Processes for authorisation to practise as a nurse practi-
43
(bedside) roles and nurse-to-patient ratios for various tioner (NP) have been introduced by professional regi-
levels of critical care unit, as well as the roles of unit stration agencies in Australia and New Zealand, with
manager and clinical nurse educator, are discussed in similar roles present in the UK and USA prior to this.
48
Chapter 2. Practice issues for critical care clinicians are Nurse practitioner roles in ‘critical care’ (or high depen-
detailed in the remaining chapters of this book. Roles dency) range from emergency department practitioners
that apply to all nursing professionals are specifically through to community-based cardiac failure specialists,
highlighted; for example: and, as noted above for the nurse consultant’s role, often
● carer, in Chapters 6, 7 and 8, all practice-related lack clarity regarding their scope of practice. 56,57 Factors
chapters in Section 2, and the specialty chapters in influencing the establishment of these roles include the
Section 3 accrediting process, defining the scope of practice through
● patient and family advocate, in Chapters 5 and 8 specific clinical practice guideline development, prescrib-
● educator, in Chapter 3. ing rights and the prevailing medical views, and the level
of support provided by health service administrators for
This section focuses on the scope of critical care nurses’ the implementation, development and evaluation of the
roles inside and external to the critical care area, and role. 48,56 Advanced practice roles in the emergency depart-
44
provides links to other specific chapters. These roles ment are the most well-established in the critical care
include: domain (see Chapter 22).
● consultant 45-47
46
48
● advanced practice /nurse practitioner roles in ICU, CLINICAL DECISION MAKING
50
49
trauma, emergency (Chapter 22), critical care out- Clinical decision making is integral to critical care nursing
51
reach /ICU liaison 52-54 (Chapter 2) practice and forms part of the clinical reasoning process.
● research/quality coordinator (Chapter 3).
Clinical reasoning is
Developing a body of knowledge and the integral role of
research and nurse researchers in that process is described the cognitive processes and strategies that nurses use to under-
in a later section of this chapter. stand the significance of patient data, to identify and diagnose
actual or potential patient problems, and to make clinical deci-
CONSULTANT sions to assist in problem resolution and to achieve positive
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Expert clinicians in one of the subspecialties of critical patient outcomes.
care – emergency, general ICU, cardiology, cardiothoracic, Clinical information and prior knowledge are therefore
neurosciences – play important roles in facilitating used to inform a decision. This section focuses on the
improvements in clinical practice for both critical care and decision-making component of clinical reasoning. A brief
non-critical care patients. The consultant’s role involves overview of the theoretical perspectives that have been
clinical practice, education, quality improvement and used to understand clinical decision making is provided
55
research activities. Within these work port folios, leader- and then studies that focus on critical care nursing
ship and the development and dissemination of knowl- are reviewed. Finally, strategies for developing clinical
edge 45,46 within a multidisciplinary team are integral to decision-making skills are provided.
47
effective practice. Practice includes role-modelling of
expected behaviours, policy and clinical guideline devel- THEORETICAL PERSPECTIVES ON
opment to support clinical care, and facilitating profes- DECISION MAKING
sional development of colleagues in collaboration with There are numerous theoretical perspectives on decision
the nurse educator role. The benefits that this role brought making, but they can be grouped into two main
to the critical care area led to the introduction of a similar categories:
service for non-critical care areas, particularly in the
context of clinical deterioration of patients or for patients 1. analytical or rationalist
recently discharged from the ICU, with the development 2. intuitive or humanistic.